Basic Information
| Provider Information | |||||||||
| NPI: | 1720048200 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURCHELL | ||||||||
| FirstName: | SHERRY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 N TUSTIN AVE | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145471915 | ||||||||
| FaxNumber: | 7145476552 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 N TUSTIN AVE | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927053528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145471915 | ||||||||
| FaxNumber: | 7145476552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 01/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | G84172 | CA | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 208600000X | G84172 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.